Basic Information
| Provider Information | |||||||||
| NPI: | 1205843315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREELEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TERRY | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | J. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 DEFENSE HWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214018943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434813354 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 BESTGATE RD | ||||||||
| Address2: | SUITES 2C & 2D | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102244442 | ||||||||
| FaxNumber: | 4102248898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 223584 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0066839 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VC0200X | D0066839 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 93335 | 01 | MA | FALLON | OTHER | 2103796 | 05 | MA | MEDICAID | K4800007 | 01 | MD | CAREFIRST BCBS | OTHER | 416933600 | 05 | MD | MEDICAID | 460284 | 01 | MA | TUFTS | OTHER | 1662090 | 01 | MA | CIGNA | OTHER | AA35636 | 01 | MA | HPHC | OTHER | 000000030737 | 01 | MA | BMC HEALTHNET | OTHER | J28729 | 01 | MA | MABC | OTHER | 412826 | 01 | RI BLUE CHIP | OTHER |